Shalender Bhasin md Atam B Singh md and Robert Christiansen md


Case #1: 23-Yr-Old Man with Adrenal Insufficiency and Hypogonadotropic Hypogonadism

Case #2: Topical Steroid Use Associated with Secondary Adrenal Insufficiency, Androgen Deficiency, and Osteoporosis Case #3: Gonadotropin-Independent Precocious Puberty Case #4: Delayed Pubertal Development and Nonpalpable Testes


Case Description

This 23-yr-old man was referred to our Endocrinology Clinic for the management of adrenal insufficiency. The patient was born of a full-term uncomplicated delivery, and grew up normally in early childhood. At 6 yr of age, he became ill, stopped growing, and developed increased pigmentation of the skin. He was evaluated at a local hospital in Mexico and diagnosed as having adrenal insufficiency. After initiation of glucocorticoid replacement therapy with 5 mg prednisone daily, his condition improved and growth resumed, but the increased skin pigmentation persisted.

At age 17 , he was evaluated at a Los Angeles Hospital for failure to develop secondary sex characteristics, and started on testosterone injections, which he takes infrequently. At the time of his clinic visit at age 23, he had not been sexually active, reported very little sexual desire, and did not shave or masturbate.

He had had mild bronchial asthma for 3 yr; his asthma was controlled with intermittent use of a metered-dose inhaler. His medications included prednisone 5 mg twice daily, 9-a fludrocortisone 0.2 mg daily, albuterol inhaler as required for bronchial asthma, sustained release theophylline 300 mg daily, and testosterone enanthate 200 mg intramuscularly every 2 wk. At the time of his clinic visit, he had not received his testosterone injections for several months.

From: Contemporary Endocrinology: Challenging Cases in Endocrinology Edited by: M. E. Molitch © Humana Press Inc., Totowa, NJ

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